Ask Dr. Tessa: Rising Cases

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"With cases appearing to be on the rise again, should I be preparing to close my business again and how can I best prepare my clients for a possible closure?"

An image of chart describing covid casesWe should all hope for the best and prepare for the worst. As an epidemiologist, I believe we should all prepare for the possibility of business closures this fall and winter. Cases are on the rise in the US and many communities are rethinking their reopening plans.1 Some scientists fear we are seeing a second wave of COVID-19 infections that are occurring after the easing of restrictions on businesses and society. On June 16, the CDC’s Anthony Fauci suggested we may still be in the first wave of infections, a resurgence of infections that only dipped slightly after restrictive social closures. Whether this is a first or second wave, winter is coming and we should be prepared for the possibilities of closures. No one wants closures. Public health workers and epidemiologists are facing the wrath of a nation on edge, some experiencing online harassment and even death threats by the public.

Many epidemiologists look to the 1918 influenza pandemic, “the Spanish flu,” for potential clues on how the SARS-CoV-2 pandemic may play out. There were at least three distinct waves of Spanish influenza in 1918 through 1919, which is estimated to have killed 50 to 100 million people worldwide.2 The first wave began in March 1918 and eased over the summer. That summer, the population very quickly returned to “life as normal,” which led to a spike of cases in many cities. The second wave came in the fall, followed by a deadly third wave during winter 1919 and spring 2020. The influenza virus is different from SARS-CoV-2 in that it’s less transmissible in the summer months; SARS-CoV-2 does not appear to have a significant seasonal aspect. However, in the summer months, we are spending more time socializing outdoors, school is not in session, and it is easier to practice social distancing. Epidemiologists fear that come winter, socializing patterns will move indoors, and the holidays will bring together multiple generations for very high-risk interactions. Parents of young children hope that school can resume in person in the fall and continue through winter, however we need to be prepared for the scenario of school closures and virtual/home school. School and childcare closures will place enormous hardship on parents who cannot work virtually.

An image of sign closed businessIn preparation for potential closures, I would begin to consider what services could be provided if you are not able to see clients face-to-face for a period of time. I am certainly not an expert on hair services, but I have heard about providers putting together nicely assembled products in pretty bags and conducting remote training on their application. I tried to perform a variety of home grooming treatments on myself, my child, and my dogs during the last stay-at-home order.  Results were not good and had to be professionally corrected. I would start asking your regular clients how they would like to be supported if there were to be closures again and consider options for alternative provision of services.

A little worst-case-scenario planning never hurt, right?




  1. Centers for Disease Control and Prevention, “Coronavirus Disease 2019 (COVID-19), Cases and Deaths in the U.S.,” accessed July 2020
  2. National Public Radio, “The 1918 Flu Pandemic Was Brutal, Killing More Than 50 Billion People Worldwide,” accessed July 20209


Please be sure to always work within your scope of practice as determined by your state and to adhere to all local and federal rules and regulations regarding COVID-19 protocols. To learn more about returning to your practice or to access free resources to assist you with reopening, access the AHP Back-to-Practice Guide!

An image of Tessa CrumeAbout the Author:

Dr. Tessa Crume is an Associate Professor in the Epidemiology Department at the Colorado School of Health at the University of Colorado Anschutz Medical Campus. Her research focuses on the development and utilization of public health surveillance systems to understand the burden of disease. She has been an academic researcher since 2011, before which she worked for a decade as an applied epidemiologist at the state and federal level, analyzing surveillance data and evaluating public health impact. Dr. Crume has taught the core epidemiology class at the Colorado School of Public Health for nine years.


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